Efficiency of the One-Stage Revision Hip Arthroplasty in Chronic Periprosthetic Joint Infection with Sinus Tract

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Background. Chronic periprosthetic joint infection (PJI) remains the one among the most severe complications of total hip arthroplasty. Presence of sinus tract assosiated with polymicrobial infection development, complexity of bacteriological diagnostics  and  damage  of  soft  tissues  lead  to  constrictions  of  one-stage  revision  hip  arthroplasty  (RHA). The  aim of this studywas to assess the influence of draining sinus tract on the outcomes of one-stage RHA in patients with chronic hip PJI.

Materials and Methods.A prospective cohort comparative study included 78 patients who underwent one-stage RHA in 2017-2020. Two groups were formed: 48 (61.54%) patients without sinus tract (WST) and 30 (38.45%) patients with sinus tract (ST).

Results. The presence of a sinus tract significantly increased the duration of a one-stage RHA in groups of ST and WST (230 and 197.5 min respectively, p = 0.02), as well as blood loss (850 ml and 700 ml, respectively, p = 0.046). Sinus tract was a reliable symptom of soft tissue local infectious inflammation (86.67%, p = 0.00031), fasciitis (36.67%, p = 0.012), purulent cavity (66.67%, p = 0.00027). The structure of the pathogens was comparable. Monobacterial infections predominated in the WST group (82.98%) and in the ST group (77.78%, p = 0.08). In most cases staphylococci were isolated. The median follow-up was 20 months for both groups. The PJI was healed in 93.0% (n = 28) patients in WST group and 82.2% (n = 43) in ST PJI (p>0.05). Postoperative evaluation in the WST and ST groups: HHS 92 and 90 points (p = 0.79), EQ-5D-5L – 0.82 and 0.78 points (p = 0.84) respectively. The proportion of patients who were indicated revision surgery with no PJI association in the ST group exceeded this indicator more than twice according to the WST group — 25 and 11.62%, respectively (p>0.05).

Conclusion.As a result of the study, there was no statistically significant difference between the outcomes of one-stage RHA in patients with and without sinus tract. Factors such as the anamnesis morbi, the soft tissues condition at the surgical site and the pathogenic microflora characteristics should be taken into account in order to achieve favourable outcomes of surgical treatment.

About the authors

V. A. Artyukh

Vreden National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: artyukhva@mail.ru
ORCID iD: 0000-0002-5087-6081

Vasily A. Artyukh—  Cand.  Sci.  (Med.)

St. Petersburg

Russian Federation

S. A. Bozhkova

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: clinpharm-rniito@yandex.ru
ORCID iD: 0000-0002-2083-2424

Svetlana A. Bozhkova— Dr. Sci. (Med.)

St. Petersburg

A. A. Boyarov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: Bojaroffaa@mail.ru
ORCID iD: 0000-0003-0493-7784

Andrey A. Boyarov— Cand. Sci. (Med.)

St. Petersburg

Ju. V. Muravyova

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: julia-muraveva@yandex.ru
ORCID iD: 0000-0002-9535-6661

Julia V. Muravyova

  St.  Petersburg

A. A. Kochish

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: aakochish@rniito.ru
ORCID iD: 0000-0001-8573-1096

Andrey A. Kochish

 St.  Petersburg


  1. Kurtz S.M., Lau E., Watson H., Schmier J.K., Parvizi J. Economic burden of periprosthetic joint infection in the United States. // J. Arthroplasty. Elsevier, 2012. Vol. 27, № 8 Suppl. P. 61-65. https://doi: 10.1016/j.arth.2012.02.022.
  2. Шубняков И.И., Тихилов Р.М., Денисов А.О., Ахмедилов М.А., Черный А.Ж., Тотоев З.А., Джавадов А.А., Карпухин А.С., Муравьёва Ю.В. Что изменилось в структуре ревизионного эндопротезирования тазобедренного сустава в последние годы? Травматология и ортопедия России. 2019;25(4):9-27. https://doi.org/10.21823/2311-2905-2019-25-4-9-27
  3. Shubnyakov I.I., Tikhilov R.M., Denisov A.O., Akhmedilov M.A., Cherny A.Z., Totoev Z.A. et al., Javadov A.A., Karpukhin A.S., Muravyeva Yu.V. What Has Changed in the Structure of Revision Hip Arthroplasty? Traumatology and Orthopedics of Russia. 2019;25(4):9-27. (In Russ.) https://doi.org/10.21823/2311-2905-2019-25-4-9-27
  4. Карбышева С., Ренц Н., Ермак К., Кабрик С., Трампуш А. Новые методы диагностики перипротезной инфекции. Травматология и ортопедия России. 2019;25(4):56-63. https://doi.org/10.21823/2311-2905-2019-25-4-56-63
  5. Karbysheva S., Renz N., Yermak K., Cabric S., Trampuz A. New Methods in the Diagnosis of Prosthetic Joint Infection. Traumatology and Orthopedics of Russia. 2019;25(4):56-63. https://doi.org/10.21823/2311-2905-2019-25-4-56-63
  6. Dale H., Fenstad A.M., Hallan G., Havelin L.I., Furnes O., Overgaard S., Pedersen A.B., Kärrholm J., Garellick G., Pulkkinen P., Eskelinen A., Mäkelä K., Engesæter L.B. Increasing risk of prosthetic joint infection after total hip arthroplasty // Acta Orthop. 2012 Oct;83(5):449-458. https://doi: 10.3109/17453674.2012.733918.
  7. Kurtz S.M., Lau E., Schmier J., Ong, Zhao K., Parvizi J. Infection Burden for Hip and Knee Arthroplasty in the United States // J Arthroplasty. 2008 Oct;23(7):984-991. https://doi: 10.1016/j.arth.2007.10.017.
  8. Diaz-Ledezma C., Higuera C.A., Parvizi J. Success after treatment of periprosthetic joint infection: a Delphi-based international multidisciplinary consensus. Clin Orthop Relat Res. 2013 Jul;471(7):2374-2382. https:// doi: 10.1007/s11999-013-2866-1.
  9. Kunutsor S.K., Whitehouse M.R., Blom A.W., Board T., Kay P., Wroblewski B.M. et al. One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies. Eur J Epidemiol. 2018 Oct;33(10):933-946. https://doi: 10.1007/s10654-018-0377-9.
  10. Lange J., Troelsen A., Thomsen R.W., Soballe K. Chronic infections in hip arthroplasties: comparing risk of reinfection following one-stage and two-stage revision: a systematic review and meta-analysis. Clin Epidemiol. 2012;4:57-73. https://doi: 10.2147/CLEP.S29025.
  11. Zahar A., Klaber I., Gerken A.M., Gehrke T., Gebauer M., Lausmann C., Citak M. Ten-Year Results Following One-Stage Septic Hip Exchange in the Management of Periprosthetic Joint Infection. J Arthroplasty. 2019 Jun;34(6):1221-1226. https://doi: 10.1016/j.arth.2019.02.021.
  12. Gehrke T., Zahar A., Kendoff D. One-stage exchange: it all began here. Bone Joint J. 2013 Nov;95-B(11 Suppl A):77-83. https://doi: 10.1302/0301-620X.95B11.32646.
  13. Thakrar R.R., Horriat S., Kayani B., Haddad F.S. Indications for a single-stage exchange arthroplasty for chronic prosthetic joint infection: a systematic review. Bone Joint J. 2019 Jan;101-B(1_Supple_A):19-24. https://doi: 10.1302/0301-620X.101B1.BJJ-2018-0374.R1.
  14. Jenny J.Y., Lengert R., Diesinger Y., Gaudias J., Boeri C., Kempf J.F. Routine one-stage exchange for chronic infection after total hip replacement. Int Orthop. 2014 Dec;38(12):2477-2481. https://doi: 10.1007/s00264-014-2466-z. Epub 2014 Jul 31.
  15. Lange J., Troelsen A., Solgaard S., Otte K.S., Jensen N.K., Soballe K. Cementless One-Stage Revision in Chronic Periprosthetic Hip Joint Infection. Ninety-One Percent Infection Free Survival in 56 Patients at Minimum 2-Year Follow-Up. J Arthroplasty. 2018 Apr;33(4):1160-1165.e1. https:// doi: 10.1016/j.arth.2017.11.024.
  16. Valle C.D., Bauer T.W., Malizos K.N. Proceedings of the International Consensus Meeting on periprosthetic joint infection. Workgroup 7: Diagnosis of periprosthetic joint infection. 2014. P.202-223. Режим доступа: https://www.efort.org/wp-content/uploads/2013/10/Philadelphia_Consensus.pdf
  17. Zimmerli W. Clinical presentation and treatment of orthopaedic implant-associated infection. J Intern Med. 2014 Aug;276(2):111-119. https://doi: 10.1111/joim.12233.
  18. Buchholz H.W., Elson R.A., Engelbrecht E., Lodenkämper H., Röttger J., Siegel A. Management of deep infection of total hip replacement. J Bone Joint Surg Br. 1981;63-B(3):342-353. https://doi: 10.1302/0301-620X.63B3.7021561.
  19. Lum Z.C., Holland C.T., Meehan J.P. Systematic review of single stage revision for prosthetic joint infection. World J Orthop. 2020 Dec 18;11(12):559-572. https://doi: 10.5312/wjo.v11.i12.559.
  20. Marmor S., Kerroumi Y., Meyssonnier V., Lhotellier L., Mouton A., Graff W., Zeller V. One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy. Front Med (Lausanne). 2020 Oct 16;7:540929. https://doi: 10.3389/fmed.2020.540929.
  21. Rowan F.E., Donaldson M.J., Pietrzak J.R., Haddad F.S. The Role of One-Stage Exchange for Prosthetic Joint Infection. Curr Rev Musculoskelet Med. 2018 Sep;11(3):370-379. https://doi: 10.1007/s12178-018-9499-7.
  22. Wolf M., Clar H., Friesenbichler J., Schwantzer G., Bernhardt G., Gruber G., Glehr M., Leithner A., Sadoghi P. Prosthetic joint infection following total hip replacement: results of one-stage versus two-stage exchange. Int Orthop. 2014 Jul;38(7):1363-8. https://doi: 10.1007/s00264-014-2309-y.
  23. Rudelli S, Uip D, Honda E, Lima AL. One-stage revision of infected total hip arthroplasty with bone graft. J Arthroplasty. 2008 Dec;23(8):1165-77. https://doi: 10.1016/j.arth.2007.08.010.
  24. Tande A.J., Patel R. Prosthetic joint infection. Clin Microbiol Rev. 2014 Apr;27(2):302-45. https://doi: 10.1128/CMR.00111-13.

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